WASH Cluster AWD/Cholera Preparedness and Response Plan Objective: The purpose of the cholera preparedness and response plan is to establish a minimum service provision for cholera and AWD outbreaks in order to control the extent and spread of AWD/Cholera outbreaks. It details which agency will coordinate response, in which locations and the protocols the responding agencies will follow. Agencies may go above and beyond the minimum level of service detailed here, but should not provide less. Key Documents – on WASH Cluster website WASH/Health Cluster and Communications Responsibilities Matrix for AWD/Cholera Response InterCluster Hygiene Promotion Plan Somalia Specific Hygiene Promotion IEC material (flip chart, 3 piles sorting picture) and northern Kenya material AWD/Cholera Preparedness and Response Fact Sheets for use by Schools, OTPs, Health Centres, and for Burial Guide to WASH in Cholera Treatment Centres Key Links WASH Cluster website: http://ochaonline.un.org/somalia/WASH WASH Cluster Somalia Hygiene Promotion and AWD/Cholera: Click the link on the WASH Cluster website, or go directly to: http://ochaonline.un.org/somalia/Clusters/WASH/HygienePromotion/t abid/7688/language/en-US/Default.aspx, for: Health Cluster website: http://healthsomalia.org SWALIM Flood Risk and Response Management Information System (daily update of current floods and river levels): http://www.faoswalim.org/subsites/frrmis/index.php WASH CLUSTER 2012
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WASH Cluster AWD/Cholera Preparedness and Response Plan
Objective: The purpose of the cholera preparedness and response plan is to establish a minimum service provision for cholera and AWD outbreaks in order to control the extent and spread of AWD/Cholera outbreaks. It details which agency will coordinate response, in which locations and the protocols the responding agencies will follow. Agencies may go above and beyond the minimum level of service detailed here, but should not provide less.
Key Documents – on WASH Cluster website WASH/Health Cluster and Communications Responsibilities Matrix for AWD/Cholera Response
InterCluster Hygiene Promotion Plan Somalia Specific Hygiene Promotion IEC material (flip chart, 3 piles sorting picture) and northern Kenya material
AWD/Cholera Preparedness and Response Fact Sheets for use by Schools, OTPs, Health Centres, and for Burial
Guide to WASH in Cholera Treatment Centres
Key Links WASH Cluster website: http://ochaonline.un.org/somalia/WASH WASH Cluster Somalia Hygiene Promotion and AWD/Cholera: Click the link on the WASH Cluster website, or go directly to: http://ochaonline.un.org/somalia/Clusters/WASH/HygienePromotion/tabid/7688/language/en-US/Default.aspx, for:
Health Cluster website: http://healthsomalia.org
SWALIM Flood Risk and Response Management Information System (daily update of current floods and river levels): http://www.faoswalim.org/subsites/frrmis/index.php
Minimum Service Provision ............................................................................. 3
Targets 3
Timeframe 3
WASH Cluster Cholera Preparedness and Response Plan ......................... 4
Preparedness and Response Plan 4
Annex 1: Responsibilities Matrix for WASH and Health Clusters for AWD Preparedness .......................................................................................... 8
Annex 2: Risk Level per District, with WASH Organisations and Regional/District Focal Points....................................................................... 14
Annex 3: Map of Cholera Risk Levels per district ..................................... 19
Annex 5: What is Cholera? ........................................................................... 22
Annex 6: Key Hygiene Promotion Messages for Cholera......................... 24
Annex 7: How to chlorinate water for drinking ......................................... 25
Annex 8: How to ensure chlorinated water safe for drinking ................. 27
Annex 9: How to make Chlorine solution for cleaning hands and floors ................................................................................................................ 28
Annex 10: How to request Chlorine from UNICEF.................................... 29
Annex 11: How to request UNICEF emergency WASH supplies ............ 30
Annex 12: Terms of Reference for Regional Focal Point and District Focal Point for AWD/Cholera and Flooding .................................. 31
Annex 13: District Reporting for AWD/Cholera and Flooding prevention and response .............................................................................. 32
Preface
This is the key WASH Cluster plan, under the overarching WASH/Health Cluster and Communications Responsibilities Matrix for AWD/Cholera Prevention and Response, which is in Annex 1. The Health Cluster has an equivalent plan.
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Minimum Service Provision
Overall response objectives
Control the extent of the outbreak and prevent the spread of AWD cholera, as per the WASH Cluster responsibility in the WASH/Health Cluster and Communications Responsibility Matrix for AWD/Cholera Prevention and Response in Annex 1.
Targets
100% of the population in high and medium risk areas with the following minimum interventions are covered1:
1. Ensuring access and use of Safe drinking water, via: a. Chlorination of unprotected sources b. Household water treatment and safe storage
2. Ensure hand washing with soap/ash (and safe hygienic practice) 3. Ensure safe excreta disposal in high risk areas:
a. Cholera Treatment Centres (CTC’s) b. Hospitals c. Wherever people report for treatment, e.g. Health Centre d. Areas of dense population (e.g. IDP settlements) as per Cluster standards (50 people
(ideally 8 households) per latrine) 4. Ensure solid waste disposal in high risk areas
a. Food handling areas, markets b. Areas of dense population (e.g. IDP settlements), with poor sanitation c. To clear drainage to prevent flooding in food handling areas, markets, CTC, Health
Facility and Nutrition Centre Total numbers
Populations at risk of cholera (as per Health Cluster Worst Case Scenario in the AWD/Cholera Preparedness and Response Plan Feb 2012):
5.6 million at risk of cholera
Timeframe
Ongoing for areas with confirmed Cholera outbreak. Mid-October, and mid- March for preparedness / prevention The response will continue in high risk areas until the end of the rainy season or three weeks
after the last confirmed case within the same district. Indicators
Access to a temporary source of safe water – includes chlorination and vouchers Access to a sustained source of safe water – includes boreholes, protected shallow wells Number of people reached with participatory hygiene promotion
1 WASH infrastructure in health Centres and CTC agreed primary responsibility of Health Cluster, with technical support from WASH Cluster as requested.
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WASH Cluster Cholera Preparedness and Response Plan
Preparedness and Response Plan
No
. Target
Minimum
Interventions Minimum Activities Standard Required Further info
1. Preparedness Preposition Chlorine
and minimum WASH
hygiene kit
Minimum WASH Hygiene Kit (on WASH Cluster website) includes:
- Jerry cans: one to be 20 liter, second can be 10 or 20 litre
- Water treatment tablets: 1 tablet per 20 L container (ideally 67 mg/L NaDCC, ideally in strips for longer life). 100 tablets per household for
three months supply – to provide 20 litres drinking water per HH per day
- Soap (3 months supply = 2400 g per household)
Minimum
WASH Hygiene Kit
(available on
website)
2. Coordination Regional Focal Point facilitate review of prevention measures, monitor
response, and facilitate action to fill gaps
District Focal Point for AWD/Cholera and Flooding to establish local links
with Health centres, for quick response and improved source
investigation. Review preparedness and response, report gaps to Regional and National Cluster
ToR for
Regional and
District Focal Points –
Annex 12
3. Ensuring access and
use of Safe
drinking water
Chlorinate unsafe water
sources
Test all protected water
sources to identify which are unsafe
Test all protected water sources (boreholes, protected shallow wells) to
confirm they are safe. To test use: a) H2S vial (for presence or absence of bacterial contamination)
b) Sanitary Survey (to identify high, medium or low risk of bacterial
contamination) Medium to longer term: Map water sources in SWIMS, marking protected or
unprotected sources
Sanitary Survey
(see WASH
Cluster website)
4. Chlorinate unprotected
wells and unsafe sources
A positive free chlorine residual at all times of the day. To be measured
for one week, at various times of the day, to confirm the dose is sufficient to achieve a positive chlorine residual at all times
If well chlorination is not able to provide safe water at all times of the
day, options include: - Household water treatment with tablet (aquatabs, watermaker)
- Bucket chlorination at the water point (the point of collection), to be done by a volunteer or NGO staff. Awareness is needed before starting
this method.
- Slow dissolving chlorine tablet (swimming pool chlorine) (UNICEF will check the feasibility)
Chlorination – Annex 7
Effective
Chlorination of shallow
wells – Annex
8
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No
. Target
Minimum
Interventions Minimum Activities Standard Required Further info
Medium/longer term: Protection of shallow wells + Establish spare parts
mechanism to maintain hand pumps
5. Chlorination of piped
water systems
Free Residual Chlorine should be maintained at 0.5 mg/l and verified
twice a day
Effective Chlorination–
Annex 8
6. 100% Household
water treatment
Household water
treatments
Household water treatment recommended to all households using private
or protected sources of water (double barrier) - Water Treatment Tablets (eg aquatabs for clear water/low turbidy or
Water maker/Pur (chlorfloc) for high turbidity - greater than 20 NTU) - Water filters for more sustainable approach
Detailed instructions in local language
Monitor use
7. Ensure
handwashing with
soap/ash, and
hygienic
practices
Behaviour
change intervention
Provision of
soap
Distribute minimum
WASH Hygiene Kit
Hygiene promotion in:
- IDP camps - Households
- Nutrition Centres - Health Centres
Mass hygiene
promotion campaign
(e.g. radio, mosques etc.)
Minimum WASH hygiene kit includes soap, jerry can and water treatment
tablets
WASH Cluster Emergency Hygiene Promotion Package (3 day training,
with trainers available across Somalia). This includes includes F-diagram, three pile sorting, and how to make ORS
Standards in InterCluster Hygiene Promotion Plan (available on WASH
Cluster website), and recommended salaries/incentives - One Community mobiliser per 500 people
- 40% of Community mobilisers should be women
- One Hygiene Promoter per 15-20 Community Mobilisers - Hygiene promotion project should be at least 6 months
- Recommended payments are: Community Mobiliser = incentive to $US30, Hygiene Promoter, for supervision = $US150-300, Field WASH/HP
Coordinator (50%) = $US 300-1000 Messages as per InterCluster Hygiene Promotion Plan (available on WASH
Cluster website)
In an outbreak:
- Disinfect affected households by patient relatives and caretakers
- Provide relatives and or caretakers of patients with soap, disinfectant (or concentrated chlorine product) and hygiene education that will allow
them to protect themselves and their relatives - Train relatives to disinfect their toilet cooking utilities and beddings etc
InterCluster
Hygiene Promotion
Plan (on WASH
website)
Key Hygiene
promotion messages for
Cholera – Annex 6
8.
Ensure
Safe
Where ever
people report
Construction of
communal latrines in
Provide toilets with hand washing facilities at Cholera Treatment Centres
(CTCs), and health facilities where cholera patients might go. This is the
Guide for
WASH in
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No
. Target
Minimum
Interventions Minimum Activities Standard Required Further info
excreta
disposal in high risk
areas
for treatment,
incl CTCs
high risk areas
responsibility of health cluster, but WASH Cluster can support CTC’s (on
website)
9. Areas of dense population
Latrines in IDP camps
or settlements
Cluster emergency standards are 50 people per latrine (ideally 8
households per latrine, to improve chance of latrine staying clean). Promote keeping toilets clean – disinfecting if possible
WASH Cluster Strategic
Operational Framework
(on website) 10. Public Places like
schools and markets
Consider sanitary facilities including handwashing stations initially
focussing on schools with feeding program
11. Ensure
solid waste disposal in
high risk areas
Food handling
areas, markets, CTC’s
Clean up campaigns in
high risk areas
E.g. IDP settlements, with poor sanitation
Clear drainage to
prevent flooding in high risk areas
In general, solid waste disposal and the cleaning of drains will not be
seen as an immediate priority, unless it can clearly prevent high risk
areas from flooding (markets, high density population areas), or where waste is mixed with faecal matter
CTC’s should not be built in areas that are prone to flooding. On request,
the WASH cluster can assist the health cluster maintain drainage around CTC’s and health facilities to further reduce those risks
12. Waste from
CTCs
Safe disposal of waste generated at the CTCs is the responsibility of
Health cluster, but WASH Cluster can support
13. Schools
and child friendly
spaces
Provide hand washing stations, sanitation, safe water & mobilize the
students and teachers to understand cholera and how to prevent it
Provide hygiene kits to schools containing IEC material (WASH and
education), water purification tablets, soap and preferably hand washing stands
Provide latrines at schools in affected areas with confirmed cholera cases,
were the decision is taken to keep the school open.
Cholera
Guides for teachers (on
website)
Assumptions behind Prevention and Response Plan
Provide a minimum quantity of 3 litres of chlorinated water per person per day for drinking water during AWD/Cholera response. (3 x 6 people = 18L per family per day)
Excreta disposal Increasing sanitation coverage nationwide is a long/medium term project, and although ensuring safe disposal of excreta should be key in the long-
term cholera response, due to the scale and size of the areas affected or at risk for emergency response, the provision of toilets or safe excreta disposal at family level is of a lower priority, than the provision of safe water supply and hygiene education. It is unlikely that good sanitation coverage will be achieved in the short term with limited resources and time.
Solid waste
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General collection of waste is not seen as an emergency priority by the WASH cluster to control the cholera outbreak.
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Annex 1: Responsibilities Matrix for WASH and Health Clusters for AWD Preparedness
(Last updated 25 February 2012)
Objective This document details the responsibilities of WASH Cluster, Health Cluster and Communications for AWD/Cholera response, to reduce the number of outbreaks and minimise lives lost. The WASH Cluster, Health Cluster, and Communications have Cluster specific AWD/Cholera Preparedness and Response Plans which provide the technical detail to meet the responsibilities agreed in this matrix. These documents are available on the Cluster websites:
Note: Responsibility is ensuring the activity is done, not necessarily doing it Definitions: CTC (Cholera treatment centres) = approx. 50 beds CTU (Cholera treatment units) = approx. 5 beds ORP (Oral rehydration point) ORD (Oral rehydration depot) RUMOURS OF ACUTE WATERY DIARRHOEA (AWD) Please report all rumours of AWD outbreaks directly to Health Cluster, copying WASH Cluster. The Health Cluster will then work with partners to verify the information (target within 96 hours). If possible please include: What is the problem (with time frame), Where is the problem, Who is affected, Source of info with contact details. Please also state that the report or correspondence is currently “unconfirmed”. Please report rumours via email TO Health Cluster team: [email protected], [email protected], [email protected], [email protected], [email protected] COPY WASH Cluster team and Zonal focal points: [email protected], [email protected], [email protected], [email protected], [email protected], [email protected], [email protected]
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Region/
Location District
Village/Muni
cipality/ Camp
Risk
Level WASH Organisations in Locality
WASH Cluster Regional Focal
Point
WASH Cluster District AWD
Lead Response Agency
Sool Taleex
Togdheer Sheikh
Togdheer Owdweyne Caritas, Buurdhab Red Sea Company
Togdheer Burco ADRA,DRC,Caritas,MoH,Buurdhad
Togdheer Buuhoodle UNICEF,TASS
Woqooyi Galbeed
Gebiley
Woqooyi
Galbeed Hargeysa M
DRC
Woqooyi
Galbeed Berbera
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Annex 3: Map of Cholera Risk Levels per district
Source: Health Cluster
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Annex 4: AWD/Cholera Emergency Assessment
Date of Visit: Compiled by: GPS coordinates:
Name of Location: Urban / Rural (circle one) District:
1. What is the population of this village/location? 2. Are there any organizations providing assistance?
a. If yes, what are they providing? b. How many villages have they covered?
3. Are there any organizations providing assistance to the AWD/Cholera outbreak?
c. If yes, what are they providing? d. How many villages have they covered?
Health: 4. What percentage/number of the population over 5 years of age has had suspected
AWD/Cholera in the last 2 weeks? This question is very difficult to answer because the real catchment population is usually unknown
5. What percentage/number of children under 5 have had suspected AWD/Cholera in the last 2 weeks? To be more specific e.g. children visiting a health facility rather than population based
Water Supply: 6. How much water can each family collect per day? 7. What water sources are available in this location – see table on next page:
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Water source
No. of
sources
% of
population using
source(s)
for drinking
No. of
functioning sources
Water treatment options used at
source (Well or chlorination,
bucket etc.)
Condition –
broken, dry, polluted,
collapsed, silted, low yield,
reduced storage capacity
Average
distance between
source(s) and users'
homes (km)
How
many
months a year
does this
source provide
water?
Lake, river, stream
Protected spring
Unprotected
spring
Unprotected Shallow well
Shallow Well with
handpump
Borehole
Water Pant
Berkhad
Other, specify:
8. Are people doing anything to improve the quality of their drinking water? Yes No 9. If yes, which treatment method(s) are used? select all that apply
Chlorination Sedimentation Simple sand filtration Cloth filtration Boiling Sun exposure
10. Do people have soap or other cleaning materials? Yes No a. If no, why not? b. If yes, when do they use soap or other cleaning materials?
11. What percentage of households knows how to prepare ORS and when to use it? 12. What percentage of the population washes their hands with soap, ash, sand or other
cleaning materials after defecating?
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Annex 5: What is Cholera? Cholera information for the public 1. What is cholera? It is a human disease starting with a sudden onset of numerous watery stools, often combined with vomiting. It leads to dehydration and death if not treated quickly. 2. What do you have to know about cholera? It’s a very contagious disease, but can be treated easily and quickly. Of those who develop the disease, 90% will have a mild or moderately severe illness with diarrhoea, which can be treated with ORS. Of the people who develop typical cholera normally less than 10% will suffer from moderate to severe dehydration. These cases should be taken to a health facility …or an isolation centre EARLY. EARLY TREATMENT IS ESSENTIAL.
3. When do you suspect cholera? As soon as you have sudden diarrhoea, watery stools and vomiting. 4. How can you get cholera? By drinking water from unsafe sources – rivers, open wells, water pans, berkads - that has not been chlorinated or boiled. By drinking water that has become contaminated because of the way, it was transported or stored. By eating food contaminated during or after preparation. By eating fruits that have not been peeled and washed. 5. How is cholera transmitted? The main mode of transmission is through contaminated food or drinking water. Faeces and vomit are infectious. Cholera is rarely transmitted directly from person to person but this is possible in areas of dense populations and poor sanitation and hygiene, such as poor urban areas and IDP camps. Persons with asymptomatic infections play an important role in the transmission of the infection. 7. What to do in case of suspected cholera?
Give the person extra fluids preferably ORS or SSS and, Take the patient immediately to a treatment centre. Inform the community of the suspected outbreak Raise awareness and disseminate key messages on cholera transmission and
prevention
Check people regularly who are in contact with cholera cases and sensitize on mode of spread. k and collect data on diarrhoea cases within the community to monitor trends
Monitor hygiene practises such as latrine use, hand washing, water handling practices and general environmental sanitation.
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Cholera information – more technical What is cholera? Cholera is one type of diarrheal disease caused by infection of the intestine with the bacterium Vibrio Cholera present in faecally contaminated water or food. Cholera is primarily linked to insufficient access to safe water and proper sanitation. Children as well as adults can get infected. Patients develop very severe watery diarrhoea and vomiting from 6 hours to 5 days after exposure to the bacterium. In these cases, the loss of large amounts of fluids can rapidly lead to severe dehydration. In the absence of adequate treatment, death can occur within hours. People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread primarily through contaminated food or drinking-water, and less frequently from person-to-person as a result of poor hygiene. The short incubation period of 2 hours to five days, enhances the potentially explosive pattern of outbreaks.
There are three clinical types of diarrhoea caused by a number of different organisms:
acute watery diarrhoea – lasts several hours or days, and includes cholera; acute bloody diarrhoea – also called dysentery; and chronic diarrhoea – lasts longer than a month
What is the difference between acute watery diarrhoea (AWD) and cholera?
Cholera is a type of acute watery diarrhoea – AWD is a symptom of cholera which can be isolated through laboratory testing. Based on a clinical definition (3 watery stools in 24 hours) confirmation of an outbreak of cholera is done through laboratory testing of the stools of an infected person.
Surveillance systems should be able to rapidly detect an increase in reported cases of acute watery diarrhoea. Such an increase should trigger efforts to determine the source of transmission and ensure implementation of control measures in the affected area. If laboratory testing confirms the presence of cholera in an area, it is assumed that there is an outbreak. Potential locations for outbreaks include:
1. Locations of previous outbreaks (hot spots) 2. Area where sanitation facilities are located within 20 m of water sources 3. An environment with poor personal hygiene (poor availability of water and poor food
handling practices) 4. Inadequate sanitation 5. A population living in crowded conditions 6. Where people use drinking water of poor quality 7. High poverty and malnutrition 8. Areas of ecological disturbances and seasonal variations in temperature and after
flooding (in endemic areas) 9. Coastal areas, areas around water bodies and around transport links.
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Annex 6: Key Hygiene Promotion Messages for Cholera Cholera - Key messages for health education
1. Cholera is a disease that causes watery diarrhoea. It causes rapid loss of water and salts from the body (dehydration) which can lead to death within hours if not treated.
2. If you or a family member have watery diarrhoea and vomiting, go to the health care
facility immediately.
3. Start drinking ORS or treated water at home and during travel to the health care facility.
4. Cholera spreads quickly. Protect yourself from cholera germs; Wash your hands with
running water and soap or ash before eating, after wiping a child’s bottom and after using the toilet/ defecating.
5. Continue breast feeding a sick child and encourage the child to eat regularly.
6. Food: COOK IT – PEEL IT – OR LEAVE IT
7. Drink safe water. Safe water is chlorinated, bottled, boiled or filtered water.
8. Use latrines: If you have no latrine, bury faeces 30 meters from any body of water
9. Thoroughly wash your hands with soap and water after taking care of people with
cholera, touching them, their stools, vomit, or clothes.
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Annex 7: How to chlorinate water for drinking The first step in the chlorination process is to make a stock solution. To make a stock solution you need to use 1 level tablespoon to every litre of water. The stock solution is what you will use to chlorinate water. Do not keep the stock solution for more than 1 week. Do not store chlorine or stock solutions in metal containers, or in direct sunlight.
How much stock solution is required? When you add chlorine to water, the chlorine starts to kill off bacteria. If the water is clean, no chlorine is used. If the water is very contaminated all of the chlorine may be used up, and there still may be more bacteria left, because the amount of chlorine used was insufficient. When chlorinating drinking water it is important to know how much chlorine is needed to kill all the bacteria, because we want to leave extra to protect the water from further contamination. This extra is called the Free Residual Chlorine (FRC), and in cholera outbreaks, we want this to be 0.5mg/l – that is 0.5 milligrams of chlorine remaining for each litre of water. Residual chlorine levels can be measured with a pool tester/comparator. The method of determining how much chlorine is required is called the jar test.
Jar Test The main method of determining the chlorine demand of the water is as follows:
1. Prepare a 1% Stock Solution of chlorine ( 1 level table spoon of HTH in 1 ltr of water)
2. Fill 4 non-metal buckets with 20L each of water to be treated 3. Add an increasing volume of 1% stock solution of chlorine to each bucket using a
syringe e.g.
1st Bucket: 1ml of 1% Stock solution 2nd Bucket: 1.5ml of 1% Stock solution 3rd Bucket: 2ml of 1% Stock solution 4th Bucket: 2.5ml of 1% Stock solution
4. Stir each bucket for 30seconds to ensure the chlorine solution is properly mixed 5. Wait a minimum of 30 minutes contact time – VERY IMPORTANT 6. Measure the levels of Free Residual Chlorine in each bucket 7. Choose the bucket, which gives approximately 0.5mg/L FRC. 8. Always recheck the chlorine demand periodically, especially when the water source
is changed or known to vary or when new batch of HTH is used. This will ensure that the FRC level is maintained. (note that the strength of HTH will reduce over time when stored at high temperatures.
9. It may be necessary to repeat the test if the water has high chlorine demand. In this case, you would put 3ml of 1% Stock solution in the first bucket, 3.5ml in the second, 4ml until a FRC of 0.5mg/l is obtained). You may need to repeat this process a third time if necessary.
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Use this result to calculate the amount of 1% stock solution to add to the total volume of water in the individual water containers.
Worked example of chlorine demand of water
This example is for the chlorination of a 5l jerry can filled with water at the well.
Follow steps 1-5 outlined above. The FRC levels of the water in the individual buckets after 30 minutes contact time were as follows:
1st Bucket: 1ml of 1% Stock solution = 0mg/L 2nd Bucket: 1.5ml of 1% Stock solution = 0.3 mg/L 3rd Bucket: 2ml of 1% Stock solution = 0.5 mg/L 4th Bucket: 2.5ml of 1% Stock solution = 0.8 mg/L
The desired FRC level therefore will be that for bucket 3 (2.0ml of 1% Stock solution in 20L= 0.5 mg/L). So if 2ml of 1% stock solution added to 20L of water gives 0.5mg/L FRC then you need a quarter (1/4) the amount of stock solution to correctly dose the a 5L water container e.g. 0.5ml of a 1% solution.
WASH (Water, Sanitation, Hygiene)
CLUSTER CHOLERA PREPAREDNESS AND RESPONSE PLAN Somalia
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Annex 8: How to ensure chlorinated water safe for drinking This was agreed in the WASH Cluster Technical Meeting held in Mogadishu on 22 November 2011, to ensure effective chlorination of shallow wells. Background The aim of WASH Cluster is to protect the population from AWD/cholera which includes access to safe drinking water. So when shallow wells are chlorinated, it is important to ensure they provide safe drinking water. “Residual Chlorine” is a measure to ensure effective chlorination. Residual Chlorine can be measured in many ways. The easiest is with a “Test Strip”, which changes colour to show the level of Residual Chlorine present in the water sample. Standard
There must always be a positive “Residual Chlorine” in shallow wells receiving
chlorination.
Agreed method to confirm effective chlorination
All wells receiving chlorination must be tested for one week, a few times a day, to
confirm there is positive residual chlorine at all times of the day. If the Residual
Chlorine is:
o Positive at all times of the day – the level of chlorination can remain the same
o Not measurable at any time throughout the day – the amount or frequency of
chlorination should increase, and the well re-tested.
If the level of chlorination cannot be increased, and there is not a positive residual
chlorine at all times of the day, an alternative method should be promoted.
Alternatives methods include:
o Household water treatment with tablet (aquatabs, watermaker)
o Bucket chlorination at the water point (the point of collection), to be done by
a volunteer or NGO staff. Providing a specific amount of chlorine directly into
each bucket after it has been filled from the unsafe source. Awareness is
needed before starting this method.
o Slow dissolving chlorine tablet (swimming pool chlorine)
WASH (Water, Sanitation, Hygiene)
CLUSTER CHOLERA PREPAREDNESS AND RESPONSE PLAN Somalia
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Annex 9: How to make Chlorine solution for cleaning hands and floors
When to use 0.05% Chlorine
When to use 0.2% Chlorine
Disinfect utensils used by cholera patients like; plates, dishes, spoons etc
Disinfect latrines that have been used by cholera patients.
Washing hands after using the toilet, handling a cholera patient, before preparing food. (If 0.05% chlorine is used, soap is not required)
Disinfect place where cholera patients have vomited or had diarrhea.
How to make Chlorine Solution
0.05 % 0.2%
With HTH 70%:
1 tablespoon in 20 litres of water
With Chlorine HTH 70%:
1 tablespoon in 5 litres of water
With Bleach 5 % (Sodium hypochlorite solution):
14 tablespoons in 20 litres of water
¼ of cup in 20 litres of water
With Bleach 5 % (Sodium hypochlorite solution):
20 tablespoons in 5 litres of water
Note: 1 table spoon = 10 mL, 1 cup = 200 mL
WASH (Water, Sanitation, Hygiene)
CLUSTER CHOLERA PREPAREDNESS AND RESPONSE PLAN Somalia
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Annex 10: How to request Chlorine from UNICEF Below are the procedures that should be followed when requesting chlorine from UNICEF. Given the AS ban, supplies can only be requested from UNICEF in areas not in Al Shabaab control. Project detailed information
Detail assessment of all the water sources to be chlorinated, the following information is needed:
1. Name of Region, District and Village where the waters sources /well is situated 2. Name of village, GPS coordinates, or well ID-region/district/village 3. Estimated target population to be served. 4. Type of water supply source: un-protected waters source (hand dug/drilled well,
water catchments/pan/pond/dam and bekard/ household). Protected water sources (hand dug/drilled wells and water tank/truck)
5. Method of abstraction (hand pump/motorized/solar powered) 6. Daily abstraction rates (M3/day) 7. Daily chlorine requirements based on the number of water sources to be
chlorinated (Should include names of well owners or names of villages where the wells are located, frequency of chlorination)
NB: These can be presented in a simple table
Issuance of chlorine from UNICEF warehouse The following documents should be in place before partners can be issued with chlorine from UNICEF warehouse
1. Duly signed agreement (PCA/SSFA) with UNICEF 2. Duly completed Request for Supplies form (on UNICEF standard format). 3. Supplies release order prepared by UNICEF WASH section. 4. WASH Officer to update the chlorine monitoring excel sheet based on all partners
requests and monitor the remaining stocks. 5. WASH Officer to review overall chlorination progress every 3 months.
WASH (Water, Sanitation, Hygiene)
CLUSTER CHOLERA PREPAREDNESS AND RESPONSE PLAN Somalia
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Annex 11: How to request UNICEF emergency WASH supplies Below are the procedures that should be followed when requesting WASH supplies from UNICEF for rapid repair of strategic water supplies. Given the AS ban, supplies can only be requested from UNICEF in areas not in Al Shabaab control. Project detailed information
Brief assessment of the water source(s) to be repaired, the following information is needed: Name of Region, District and Village where the water supply is situated
1. Name of village, GPS coordinates, 2. Estimated target population currently relying on supply, including estimated
livestock numbers. 3. Type of water supply (water yard, borehole, hand dug/drilled wells) 4. Details of extraction equipment (pump – make and model, generator – make &
model/power rating). Standby generator – make/model/power rating 5. Daily abstraction rates (M3/day) 6. Nature of breakdown. When did breakdown occur? What part of the system is
not working? What action has been taken so far? NB: These can be presented in a simple table and/or sent on an email.
Issuance of supplies from UNICEF warehouse Note: UNICEF will only issue supplies to its partners and only after the above information has been received. The following documents should be in place before partners can be issued with supplies from UNICEF warehouse:
1. Duly signed agreement (PCA/SSFA) with UNICEF 2. Duly completed Request for Supplies form (on UNICEF standard format). 3. Supplies release order prepared by UNICEF WASH section. 4. Partner to report on action taken using supplies 5. WASH Officer to inform WASH Cluster Coordinator when supply is functioning.
Under exceptional circumstances UNICEF can loan supplies to NGOs/communities to repair catastrophic breakdown but only after verification of the needs by a reliable third party.
WASH (Water, Sanitation, Hygiene)
CLUSTER CHOLERA PREPAREDNESS AND RESPONSE PLAN Somalia
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Annex 12: Terms of Reference for Regional Focal Point and District Focal Point for AWD/Cholera and Flooding The Regional and Deputy regional focal points are the Cluster points of contact who undertake facilitation of cluster activities at the field level, share information and response planning with the overall objective of identifying gaps, preventing duplication and ensuring an effective response. This document summarises the roles and responsibilities of WASH Cluster Regional, Deputy and District AWD/Flooding Focal Points. Focal Point Role and Responsibility
Regional
Identify partners in the region, where they are working, and identify
any gaps and overlaps in the districts. Inform WASH Cluster Team to
update the 4W matrix if required Facilitate field coordination meetings to share information, identify
common problems. If problems can’t be addressed at regional level,
request support from Zonal focal point or WASH Cluster team
Facilitate joint needs assessments and monitoring missions to prioritise
needs in the region, as required or requested – in coordination with OCHA field officer
Facilitate implementation of standards and guidelines,
Ensure appropriate information exchange between the cluster members
in the field and Nairobi based Cluster team
Ensure the Cluster coordinator and OCHA field officers are informed of
cluster specific developments in the region
Disseminate key WASH documents to members
Jointly with the Zonal focal point, coordinate AWD/Flood Preparedness
and Response for the WASH Cluster at District level.
Establish strong working relationships with all the cluster members in
order to facilitate effective collaboration and communication
Deputy Regional
Support Regional Focal point to follow up with the WASH cluster team
to update the 4W matrix and guide members who have a problem filling out the 4W matrix
Chair the regional meetings in case the regional focal point is absent
and write meeting minutes
Proactively share information with the cluster members
District AWD/
Flooding
Collect information on existing AWD outbreaks and floods and share
with Nairobi WASH cluster, SWALIM and the regional Focal point for onward response
Identify gaps during AWD/Flooding, who is responding, supplies needed
and share information during the regional cluster meetings Monitor river levels through observation and through SWALIM websites
and share the information during the regional cluster meetings
Support establishment of a multidisciplinary taskforce for AWD/Cholera
for each region, including community members, ideally led by local
health facility
Establish coordination with other WASH agencies working in district
WASH Cluster
Agency
Share information with District Focal Point
Update 4W matrix to avoid overlaps and gaps
Attend Regional WASH Cluster meeting
WASH (Water, Sanitation, Hygiene)
CLUSTER DISTRICT REPORTING for AWD/CHOLERA and FLOODING Prevention and Response
Somalia
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Annex 13: District Reporting for AWD/Cholera and Flooding prevention and response WEEKLY REPORT for WASH Cluster District Lead Agency for AWD/Cholera and Flooding Due date: End of each week – if there are changes to report
Region / District: ………………………… WASH Cluster District Lead Agency for AWD/Cholera and Flooding: …………………… Contact (name, email, phone number):……………………………… Date submitted: ……………………..
PREPAREDNESS for Outbreaks and Flooding (please update only if there are changes)
Location Prevention Response Gaps
In the past three years, where are the most likely
locations in your district
for AWD/cholera outbreaks?
Are key unprotected wells being chlorinated?
(Y/N)
Please list organisations doing the chlorination
Are organisations distributing WASH items (for example: jerry
cans, soap, aquatabs)? (Y/N)
Please list the organisations doing this
Is Hygiene Promotion taking place? (Y/N) and is it as per
the WASH Cluster Hygiene
Promotion Package Please list organisations
Is an agency ready to respond to an outbreak
– with capacity and
supplies? Please list the organisation
What are the remaining gaps?
Report these to
Regional Cluster meeting for action
Preparedness activities in place in the district?
Are WASH preparedness supplies (chlorine, aquatabs, soap, jerry cans) available? (Y/N)
If so, with which agencies, and are they at Regional or District level
Do Health centres/clinics have supplies of chlorine and soap? (Y/N) (It is Health’s responsibility, but WASH can support)
Have organisations who are doing AWD/Cholera preparedness or response submitted a 4W matrix (Y/N). (Contact Shem Okiomeri, [email protected], WASH Cluster Information Management Specialist, if you need support for 4W)